Bacteria that produce carbapenemases, such as the K. pneumoniae carbapenemase (blaKPC), are increasingly common multidrug resistant pathogens causing nosocomial infections and outbreaks, with high rates of morbidity and mortality worldwide. Extensive routine in-house surveillance and screening is performed in the Clinical Center. All blaKPC/blaNDM-1 PCR positive isolates are sequenced for epidemiological and research purposes. Overall, we have a very low presence of CPOs, with data analysis suggesting that for most of patients who are positive for CPOs, it is likely that the bacteria were acquired outside of the institution. Environmental surveillance can be useful to identify the source of an outbreak, test efficacy of preventative infection control measures, and, more recently, to better understand the microbiome of the hospital. We are investigating the flora of the hospital environment at a closer level then has been done previously, and performing genomic analyses on identified resistant organisms as well as comparing the new sequences to the database of information obtained on patients over multiple years.